Hi All,
Please see the 9 responses (thankyou to all!) -have anonymised
1.You should spend more time pursuing activities that thin your own knee
cartilage
Short answer – doesn’t matter
2. I must admit I’m a bit of an undercaller. If I see mild generalised thinning I will give a statement like "the articular cartilage is generally well maintained", particularly if they’re old and particularly if I don’t think it’s contributing to their symptoms. It’s a tough one though. I think if there is any hint of undulation I probably frequently call "ulceration" which may not correlate well arthroscopically.
3. I tend to use “thinning” as synonymous with “wear” – I think it implies loss and I use when I think abnormal.
If I think it may be effectively normal, I tend to describe as “relatively low volume” of articular cartilage that is not definitely abnormal and may reflect individual variance.
Not sure if this comes across as more neutral or doesn’t matter…
4. One loses Cartilage to the tune of 1 to 3% per year after the age of 30 years and the best place to compare is usually the far posterior condyle where the Cartilage is normal.
Our structured report comments on cartilage loss as grades 1-4 as I have sent reports before. We use a checklist approach with responses of pathologic terms embedded in powerscribe (version 3 of my book). Its got cartilage features- thinning/fissure/defect/denuding etc. and subchondral bone features- cyst/edema/sclerosis and combos.
Arthroscopic surgeons report gr1, gr2/3, gr 4. It is difficult for them to differentiate grade 2 from grade 3. they love our reports.
Like Steve Jobs said, unless one received iPhone in their hand, they didn’t know what it was.
Similarly, we create a branded report with virtual pathology details, and not try to match a rad report with arthroscopy report or what a novice surgeon may say in the report and not identify different cart lesions.
We as radiologists have to set our own standards.
Granted, in an older patient, these may not be relevant, but we should not discriminate by age and just report what we see as no one should be left behind (quote Obama).
Age is also a number and I see arthroscopy is being done in 70 year olds for internal derangement. i’ve also seen Cartilage being repaired and replaced for somebody who has broad areas of denuded Cartilage over a large portion of condyle with underlying renal disease- since they were in their mid 40s and not old and the orthopedic surgeon did not want to replace the knee.
5. I look at the radiographs.
6. If there are no other findings of arthropathy in that compartment (marginal osteophytes, subchondral edema, etc) and no focal defect, I do not even mention this as I believe it is artifactual.
I agree it is more vexing when there are large marginal osteophytes but normal marrow signal and smooth cortex. In those cases I will describe it similar as you.
I could go on with example situations, but that’s how I do it.
7. Hi. I generally report it as mild or moderate diffuse thinning, without any disclaimers. Granted, it can be difficult to know if it’s real or abnormal, especially reading from a lot of different instruments, but no one has complained about me reporting this (yet) and at least one orthopedist has requested that I report it.
8. Are you talking about the chemical shift artifact making one side look thin while the other side looks thick? (No I wasn’t referring to this, but after looking it up,learnt something new!)
9. I just say mild/moderate diffuse cartilage thinning
10. I report it exactly as you do
Regards and Thanks again to everyone who responded.
Daniel Saddik
Hi Ocaders
As a separate discussion on cartilage…
We all see on knee MRI diffuse “apparent” chondral thinning of what looks to be mild or moderate degree- in the abscence of a focal chondral defect. This may not be pathological. (Due to this it has always puzzled me how some MR studies can claim such a high degree of accuracy in cartilage disease).
I’m never sure how to report this.
I might say “apparent mild or moderate diffuse chondral thinning which may not translate arthroscopically. In particular there is no focal chondral defect.”
How do others approach this?
Will collate responses and post.
Regards
Daniel
